From the Guidelines
Dry needling and trigger point injections (TPIs) are distinct techniques for treating myofascial pain, with dry needling involving the insertion of thin filiform needles into trigger points without injecting any substance, whereas TPIs use hollow hypodermic needles to deliver substances directly into the trigger point. The primary difference between the two techniques lies in their approach to treating trigger points. Dry needling relies on the mechanical disruption of the trigger point by the needle itself, causing a local twitch response that helps release muscle tension [no direct evidence from 1]. In contrast, trigger point injections provide both mechanical disruption and pharmacological effects to reduce pain and inflammation by delivering substances such as local anesthetics, corticosteroids, saline, or botulinum toxin directly into the trigger point [no direct evidence from 1]. Some key considerations when choosing between these techniques include the specific condition being treated, pain severity, and provider expertise. While dry needling is typically performed by physical therapists or chiropractors, trigger point injections are usually administered by physicians. It is essential to note that the evidence for some physical therapy modalities, including dry needling, is conflicting, and the adverse effects, as well as the cost and time required, probably outweigh any benefits 1. However, expert clinicians who reviewed the recommendations were largely in agreement with the use of dry needling, despite some reservations regarding its use in the early phase of rehabilitation 1. Ultimately, the choice between dry needling and trigger point injections should prioritize the patient's safety, comfort, and desired outcomes, taking into account the potential risks and benefits of each technique. Key differences between the two techniques include:
- The use of substances in TPIs versus the absence of injections in dry needling
- The potential for immediate pain relief with TPIs due to the anesthetic effect
- The risk of soreness for 24-48 hours after dry needling
- The difference in provider expertise and training for each technique.
From the Research
Difference between Dry Needling and Trigger Point Injections (TPIs)
- Dry needling involves the insertion of thin, monofilament needles into muscles, ligaments, tendons, subcutaneous fascia, and scar tissue without the use of injectate 2
- Trigger point injections (TPIs), on the other hand, use hollow-bore needles to deliver substances such as corticosteroids, anesthetics, or botulinum toxins into the affected area 2
- Dry needling is often used to treat myofascial trigger points (MTrPs), which are areas of hyperirritable muscle tissue that can cause pain and stiffness 3, 4
- TPIs are also used to treat MTrPs, but they involve the injection of a substance into the trigger point, whereas dry needling does not 5
Comparison of Dry Needling and TPIs
- A study comparing lidocaine injection, botulinum toxin injection, and dry needling to trigger points in myofascial pain syndrome found that all three treatments improved pain pressure thresholds and pain scores, but lidocaine injection was more effective in improving visual analog scores and quality of life 5
- Dry needling has been shown to be effective in reducing pain and improving range of motion, but its effects may be shorter-lived compared to TPIs 4, 6
- The choice between dry needling and TPIs may depend on the individual patient's needs and preferences, as well as the specific condition being treated 5
Mechanisms of Dry Needling and TPIs
- Dry needling is thought to work by stimulating nerve endings and altering the chemical environment of trigger points, leading to reductions in pain and inflammation 3, 4
- TPIs, on the other hand, work by delivering a substance directly into the trigger point, which can help to reduce pain and inflammation by blocking nerve conduction or reducing muscle spasms 2, 5